Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-23T20:29:37.488Z Has data issue: false hasContentIssue false

Chapter 2 - The Epidemiology of Mental Illness in Older People in Acute Hospitals

A Growing Challenge for the Liaison Psychiatrist

Published online by Cambridge University Press:  04 April 2024

By
Christiana Elisha-Aboh  and
George Crowther
Edited by
George Tadros  and
George Crowther
George Tadros
Affiliation:
Aston University, Birmingham
George Crowther
Affiliation:
Leeds and York Partnership NHS Foundation Trust, Leeds
Get access

Summary

Epidemiology studies how regularly diseases occur in different groups of people and why – hence its pivotal role in planning the distribution of resources. This chapter focuses on the epidemiology of mental illnesses in older people in acute hospitals and highlights the role of the liaison psychiatrist and other mental health professionals in bridging the gap between physical and mental disorders. By outlining the intricate connection between the two, it explains why careful consideration and a high index of suspicion are needed when assessing older persons in the acute hospital. Emphasis is placed on the importance of viewing ageing as a normal biological and social construct rather than a problematic disease process to which a figurative cut-off point can be applied. The chapter gives prominence to the mammoth social and economic burden of mental disorders, borne by all in society.

The chapter has subsections on important epidemiological terminologies, life expectancy, the prevalence of common psychiatric disorders in acute general hospitals (including emergency departments), and the influence of COVID-19 on the prevalence of mental disorders in older persons. It sounds a clarion call to challenge current practice, work synergistically with all stakeholders, and embrace change if a crisis is to be averted.

Keywords

acute hospitalscommon mental disorderscommon psychiatric disordersCOVID-19emergency departmentsepidemiology life expectancyolder personsprevalencetrends
Type
Chapter
Information
Handbook of Old Age Liaison Psychiatry , pp. 24 - 37
Publisher: Cambridge University Press
Print publication year: 2024

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Coggon, D., Rose, G., and Barker, D.J.P. What is epidemiology? In their Epidemiology for the Uninitiated (4th ed.), 1997. BMJ resources for readers. www.bmj.com/about-bmj/resources-readers/publications/epidemiology-uninitiated/1-what-epidemiology.Google Scholar
Minett, T., Brayne, C., and Stephan, B.C.M. Epidemiology of old age psychiatry: An overview of concepts and main studies. In Thomas, A. and Dening, T., Oxford Textbook of Old Age Psychiatry (3rd ed.). Oxford: Oxford University Press, 2020, pp. 45–76.CrossRefGoogle Scholar
NHS England. Improving care for older people. NHS 75, n.d. www.england.nhs.uk/ourwork/clinical-policy/older-people/improving-care-for-older-people.Google Scholar
Goldie, I., Elliott, I., Regan, M. et al. Mental Health and Prevention: Taking Local Action. Policy report. London: Mental Health Foundation, 2016 (here pp. 1–41).Google Scholar
The Five Year Forward View for Mental Health: A Report from the Independent Mental Health Taskforce to the NHS in England. NHS, February 2016 (here pp. 4–32). www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf.Google Scholar
Royal College of Psychiatrists. Who Cares Wins: Improving the Outcome for Older People Admitted to the General Hospital: Guidelines for the Development of Liaison Mental Health Services for Older People. London: RCP, 2005 (here pp. 5–40). www.bgs.org.uk/sites/default/files/content/resources/files/2018-05-18/WhoCaresWins.pdf.Google Scholar
Parsonage, M., Fossey, M., and Tutty, C. Liaison Psychiatry in the Modern NHS. Report. London: Centre for Mental Health, 2012 (here pp. 3–4). www.centreformentalhealth.org.uk/sites/default/files/2018-09/Liaison_psychiatry_in_the_modern_NHS_2012_0.pdf.Google Scholar
Treat as One: Bridging the Gap between Mental and Physical Healthcare in General Hospitals. Report, National Confidential Enquiry into Patient Outcome and Death (NCEPOD), 2017 (here pp. 6–10). www.ncepod.org.uk/2017report1/downloads/TreatAsOne_FullReport.pdf.Google Scholar
Department of Health. Annual Report of the Chief Medical Officer 2013: Public Mental Health Priorities: Investing in the Evidence. London: Department of Health and Social Care, 2014. assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/413196/CMO_web_doc.pdf.Google Scholar
Naylor, V., Parsonage, M., McDaid, D. et al. Long-Term Conditions and Mental Health: The Cost of Co-Morbidities. London: Kings Fund Centre for Mental Health, 2012.Google Scholar
Singh, I., Ramakrishna, S., and Williamson, K. The rapid assessment interface and discharge service and its implications for patients with dementia. Clin Interv Aging 2013, 8: 1101–8.Google ScholarPubMed
Tadros, G., Salama, R.A., Kingston, P. et al. Impact of an integrated rapid response psychiatric liaison team on quality improvement and cost savings: The Birmingham RAID model. Psychiatrist 2013, 37: 4–10. doi: 10.1192/pb.bp.111.037366.CrossRefGoogle Scholar
Holmes, J. Liaison old age psychiatry. In Dening, T. and Thomas, A. (eds), Oxford Textbook of Old Age Psychiatry (2nd ed.). Oxford: Oxford University Press, 2013, pp. 325–34.Google Scholar
Royal College of Psychiatry. Liaison Psychiatry for Every Acute Hospital: Integrated Mental and Physical Healthcare. www.rcpsych.ac.uk/docs/default-source/members/faculties/liaison-psychiatry/cr183liaisonpsych-every-acute-hospital.pdf?sfvrsn=26c57d4_2.Google Scholar
Burns, A., and Warner, J. Better access to mental health services for older people. Blog, 9 October 2015. www.england.nhs.uk/blog/mh-better-access.Google Scholar
Department of Health. National Service Framework for Older People. 2001, pp. 7–40. assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/198033/National_Service_Framework_for_Older_People.pdf.Google Scholar
Palmer, L., Hodge, S., Ryley, A. et al. Psychiatric Liaison Accreditation Network (PLAN): National Report 2012–2015. London: Royal College of Psychiatrists, 2016. www.rcpsych.ac.uk/docs/default-source/improving-care/ccqi/quality-networks/psychiatric-liaison-services-plan/plan-publications-and-links-national-report-2012-15.pdf?sfvrsn=3814f12_2.Google Scholar
Thompson, F., and Baker-Glenn, E. Liaison old age psychiatry. In Dening, T. and Thomas, A. (eds), Oxford Textbook of Old Age Psychiatry (3rd ed.). Oxford: Oxford University Press, 2020, pp. 347–61.Google Scholar
Department of Health, Closing the gap: priorities for essential change in mental health, January 2014, https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/281250/Closing_the_gap_V2_-_17_Feb_2014.pdf.Google Scholar
NHS England, the National Collaborating Centre for Mental Health, and the National Institute for Health and Care Excellence. Achieving Better Access to 24/7 Urgent and Emergency Mental Health Care, Part 2: Implementing the Evidence-Based Treatment Pathway for Urgent and Emergency Liaison Mental Health Services for Adults and Older Adults: Guidance. NHS England Publications Gateway Reference 05958. November 2016. www.england.nhs.uk/wp-content/uploads/2016/11/lmhs-guidance.pdf.Google Scholar
Rodda, J., Boyce, N., and Walker, Z. The Old Age Psychiatry Handbook: A Practical Guide. Hobocken, NJ: John Wiley & Sons Ltd, 2008 (esp. pp. 23–244).Google Scholar
Oxford Learner’s Dictionaries. Oxford: Oxford University Press, 2021. www.oxfordlearnersdictionaries.com.Google Scholar
Centres for Disease Control and Prevention. Epidemiology Glossary. Data and Statistics, n.d. www.cdc.gov/reproductivehealth/data_stats/glossary.html.Google Scholar
Hospitals on the Edge? The Time for Action: A Report by the Royal College of Physicians. September 2012. Download from www.rcplondon.ac.uk/guidelines-policy/hospitals-edge-time-action.Google Scholar
Imison, C., Poteliakhoff, E., and Thompson, J. Older People and Emergency Bed Use. Exploring Variation. London: King’s Fund, 2012.Google Scholar
Cassar, S. A. Hodgkiss, A., Ramirez, A. et al. Mental health presentations to an inner-city accident and emergency department. Psychiatric Bulletin 2002, 26(4): 134–6.CrossRefGoogle Scholar
Javadi, S.M.H., and Nateghi, N. Covid-19 and its psychological effects on the elderly population. Disaster Medicine and Public Health Preparedness 2020 14(3): 40–1.CrossRefGoogle ScholarPubMed
NHS England, Operational Information for Commissioning. A & E attendances and emergency admissions. Monthly report, December 2016. www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2016/06/Monthly-AE-Report-December-16.pdf.Google Scholar
NHS digital. Hospital Accident & Emergency activity. September 2020. https://digital.nhs.uk/data-and-information/publications/statistical/hospital-accident--emergency-activity/2019-20/further-information.Google Scholar
Crowther, G., Chinnasamy, M., Bradbury, S. et al. Trends in referrals to liaison psychiatry teams from UK emergency departments for patients over 65. Int J Geriatr Psychiatry 2021, 36(9): 1415–22. doi: 10.1002/gps.5547.CrossRefGoogle ScholarPubMed
Healthcare Safety Investigation Branch. Provision of mental health care to patients presenting at the emergency department. Investigations and Reports, November 2018. www.hsib.org.uk/investigations-and-reports/provision-mental-health-care-patients-presenting-emergency-department.Google Scholar
Anderson, D., and Ooman, S. Liaison psychiatry and older people. In Guthrie, E., Rao, S., and Temple, M. (eds), Seminars in Liaison Psychiatry (2nd ed.), London: Royal College of Psychiatrists, 2012, pp. 265–87.Google Scholar
Mental Health Foundation. Mental health statistics: The most common mental health problems. Mental Health Statistics, 2023. www.mentalhealth.org.uk/statistics/mental-health-statistics-most-common-mental-health-problems.Google Scholar
Sampson, E.L., Blanchard, M.R., Jones, L. et al. Dementia in the acute hospital: Prospective cohort study of prevalence and mortality. Br J Psychiatry 2009, 195 (1): 61–6.CrossRefGoogle ScholarPubMed
World Health Organization. Ageing and health. Update of 4 October 2021. www.who.int/news-room/fact-sheets/detail/ageing-and-health.Google Scholar
Fick, D., Agostini, J., and Inouye, S. Delirium superimposed on dementia: A systematic review. Journal of the American 2002, 50(10): 1723–32. doi.org/10.1046/j.1532-5415.2002.50468.Google ScholarPubMed
Fick, D., and Foreman, M. Consequences of not recognizing delirium superimposed on dementia in hospitalized elderly individuals. J Gerontol Nurs 2000, 26: 30–40.CrossRefGoogle Scholar
Walker, J., Niekerk, M., Hobbs, H. et al. The prevalence of anxiety in general hospital inpatients: A systematic review and meta-analysis. Gen Hosp Psychiatry 2021, 72: 131–40.CrossRefGoogle ScholarPubMed
Modekar, A., and Spence, S. Personality disorder in older people: How common is it and what can be done? BJPsych Advances 2008, 14(1): 71–7.Google Scholar
Muller, A., McNamara, M., and Sinclair, D. Why does Covid-19 disproportionately affect older people? Open-Access Impact Journal in Aging 2020, 12(10): 9959–81.Google Scholar
Centres for Disease Control and Prevention. Covid data tracker. https://covid.cdc.gov/covid-data-tracker/#datatracker-home.Google Scholar
Worldometers. Covid-19 coronavirus pandemic. www.worldometers.info/coronavirus.Google Scholar
Dagan, N., Barda, N., Kepten, E. et al. BNT162b2 mRNA Covid-19 vaccine in a nationwide mass vaccination setting. N Engl J Med. 2021, 384(15): 1412–23.CrossRefGoogle Scholar
Thompson, M.G., Burgess, J.L., Naleway, A.L. et al. Interim estimate of vaccine effectiveness of BNT162b2 and mRNA-1273 Covid-19 vaccines in preventing SARS-CoV-2 infection among health care personnel, first responders, and other essential and frontline workers, eight US locations, December 2020–March 2021. Morbidity and Mortality Weekly Report (Weekly MMWR) 2021, 70(13): 495–500.CrossRefGoogle ScholarPubMed
Centres for Disease Control and Prevention. Covid-19 risks and information for older adults. https://www.cdc.gov/aging/covid19/index.html.Google Scholar
Murthy, P., and Narasimha, V.L. Effects of the Covid-19 pandemic and lockdown on alcohol use disorders and complications. Current Opinion in Psychiatry 2021, 34(4): 376–85.CrossRefGoogle ScholarPubMed
WHO. Covid-19 disrupting mental health services in most countries: WHO survey. 5 October 2020, News release. https://bit.ly/3QghRzU.Google Scholar
Chen, S., Jones, P.B., Underwood, B.R. et al. The early impact of Covid-19 on mental health and community physical health services and their patients’ mortality in Cambridgeshire and Peterborough, UK. J Psychiatry Res 2020, 131: 244–54.CrossRefGoogle ScholarPubMed
Sampson, E., Wright, J., Dove, J. et al. Psychiatric liaison service referral patterns during the UK Covid-19 pandemic: An observational study. Eur J Psychiatry 2022, 36(1): 35–42.CrossRefGoogle ScholarPubMed
Varatharaj, A., Thomas, N., Ellul, M. et al. Neurological and neuropsychiatric complications of Covid-19 in 153 patients: A UK-wide surveillance study. Lancet Psychiatry 2020, 7(10): 875–82.CrossRefGoogle ScholarPubMed
McDaid, D. Viewpoint: Investing in strategies to support mental health recovery from the Covid-19 pandemic. European Psychiatry 2021, 64(1): e32.CrossRefGoogle ScholarPubMed
Ruddy, R., and House, A. Meta-review of high-quality systematic reviews of interventions in key areas of liaison psychiatry. Br J Psychiatry 2005, 187: 109–20.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×